Upper Lid Surgery on Asian Eyes a Cosmetic Challenge

Leslie Sabbagh

by Leslie Sabbagh | August 16, 2010 @ 03:00PM

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During upper eyelid surgery for Asian eyes, the first caveat is that beginning surgeons should err on the conservative side when dermining how much skin and fat to remove. The second is that not all Asian eyes are the same. For example, fat distribution is different among Koreans, Vietnamese, and Chinese, noted Nazih Haddad, M.D. Their third caveat is to know if the patient prefers a round or almond-shaped eye (more up-titled laterally and superiorly).

Challenges in performing cosmetic upper lid Blepharoplasty in Asian eyes compared with Caucasian eyes are several: first, Asian skin tends to be thicker, and that means a great danger of hypertrophic scars. To avoid this complication, he closes the wound with six to 10 fast-absorbing plain sutures that disintegrate after one week. Very fine nylon sutures, he said, should be removed as soon as possible to avoid potential scarring.

Heavy upper lids The heavier Asian upper lids, thanks to the levator aponeurosis not inserting on the skin to the larger amount of fatty tissue, also present cosmetic challenges.

"Some patients want to look very different and prefer a deep crease," he said. "Others would like to retain some of their Asian features. For the latter, I remove a small amount of skin. But for those who prefer a more Western look, I remove more skin."

Another difference is that Asians tend to have more fat than Caucasians, Dr. Haddad, aesthetic plastic surgeon in Newport Beach, Calif. suggests that it be removed under local assisted anesthesia so that patients can open and close their eyes. This allows the surgeon to know when enough has been removed.

The location of the fat is also different: more fat is usually present in the medial and central compartments, and some fat is present in the lateral compartment.

Brow fat can enter the muscle high in the orbital rim area.

This should be removed or cauterized, he said. Also, some orbicularis oculi should be removed; he usually removes as much muscle as skin (in Caucasians, less muscle than skin is excised). The amount of orbicularis oculi removed should be the same length inferiorly (close to the tarsal) as the skin.

Finally, Dr. Haddad closes with three-point sutures – skin, peritarsal tissue, and skin. 

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